Cardiovascular

Question 1

Risk factors of DVT

Answer 1

Immobilization, smoking, meds (i.e. OCP, HRT), pregnancy, recent travel, recent surgery, trauma

Question 2

Criteria for LVH

Answer 2

The most commonly used are the Sokolov-Lyon criteria (S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm).

S-wave in V3 + R-wave in AVL
> 21 in women
> 28 in men

R-wave in AVL
> 9 in women
> 11 in men

Question 3

Criteria for RVH

Answer 3

Tall R-waves in V1 or V2. R-wave Deviation

Question 4

Ways to break A-flutter

Answer 4

Adenosine 6mg
Blow into a syringe
Lift left leg

Question 5

ST-elevation

Answer 5

ST-elevation should be
>1 for first two columns
>2 or > 1.5 in the third column
> 1 in the last column

Question 6

3 Self Help Strategies for CHF

Answer 6

1. Sodium Restriction to 2300 mg per day
2. Weight loss if BMI > 40
3. Avoid NSAIDs

Question 7

Patients with a Hx of Angioedema should avoid which medication

Answer 7

ACE - I

ARBs are OK.

Question 8

Primary Tx for Hypovolemic Hyponatremia

Answer 8

Increase Salt and Water Intake.

Question 9

What device is needed for patients w/ CHF and a prolonged QRS? (> 100ms)

Answer 9

Biventricular Pacing

Question 10

What device is needed for a low EF? < 35%?

Answer 10

Defibrillator

Question 11

Should patients on optimal medical management with Stage D CHF who have expected survival < 1-2 years receive a defibrillator?

Answer 11

No. It will not affect their mortality.

Question 12

Heart Failure Stage A - Definition

Answer 12

Pt w/ Hx of HTN, DM, Obesity, Metabolic Syndrome, Atherosclerotic Disease

Question 13

Heart failure Stage B - Definition

Answer 13

Pt w/ evidence of Structural Heart Disease but asymptomatic. This includes hx of MI, asymptomatic valvular disease, e/o L. Ventricular Remodeling (LVH, Reduced EF)

Question 14

Heart Failure Stage C - Definition

Answer 14

Pt w/ evidence of structural heart disease and symptoms or hx of symptoms

Question 15

Heart Failure Stage D - Definition

Answer 15

Pt with refractory heart failure requiring specialized intervention

Question 16

Is stress testing needed for patients with known L. Ventricular Dysfunction and Angina?

Answer 16

No. Next step would be cath and revascularization.

Question 17

How to uptitrate BB?

Answer 17

The beta blocker trials (MERIT, CIBIS, COMET) increased the doses every 2 weeks - I would use that interval usually.
I have moved towards titrating by phone recently. If someone is feeling well without symptoms of congestion (no dyspnea and no edema), then I am comfortable increasing the beta blocker without an appointment.
But if LVEF is very low, if hypotensive, or if other concerns then I do book them in follow-up sooner to titrate up in person.
In regards to ACEi/ARB though, those can be increased more quickly just depending on blood pressure. If blood pressure is consistently 150/90 mmHg for example, you could just jump straight to lisinopril 40 mg nightly. With ACEi/ARB there is immediate benefit and no transient reduction in cardiac output, so you can titrate those up more quickly just based on blood pressure.